Trans-Radial Approach for Catheterisation in Non-ST Segment Elevation Acute Coronary Syndrome: An Analysis of Major Bleeding Complications in the ABOARD Study

Study Questions:

What are the incidence, type, and implications of major bleeding in patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with an invasive strategy using predominantly the radial approach and triple antiplatelet therapy?

Methods:

This was a secondary analysis from the ABOARD trial. In this trial, 352 patients with NSTE-ACS were randomized to an “immediate percutaneous coronary intervention (PCI)” strategy or a strategy of PCI on the “next working day.” Radial access was predominantly used in this study population. The authors assessed the occurrence of major bleeding complications and their association with mortality at 1 month.

Results:

Patients were treated with triple antiplatelet therapy using high loading and maintenance doses of clopidogrel and abciximab in 99% of patients receiving PCI. The transradial approach was used in 84% of patients. Major bleeding occurred in 5.4% of patients (n = 19), with no difference between immediate and delayed intervention. The most common bleeding complications were occult bleeding (36.8% of bleeding, n = 7/19) and overt gastrointestinal bleeding (21% of bleeding, n = 4/19). Patients with major bleeding had a dramatically higher 30-day mortality (26.3% vs. 0.6%; odds ratio, 50.3; 95% confidence interval, 10.1-249.7; p < 0.0001).

Conclusions:

The authors concluded that major bleeding is not uncommon in patients undergoing PCI using a predominantly radial approach, and is associated with a high mortality rate.

Perspective:

Major bleeding after PCI has been consistently associated with adverse outcomes, and this study suggests that radial access does not negate the risk of bleeding completely. The major site of bleeding in these patients was gastrointestinal, and further studies are warranted to identify strategies that can reduce the incidence of bleeding in these patients.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Myocardial Infarction, Acute Coronary Syndrome, Percutaneous Coronary Intervention


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